Question from a young Indian doctor who just passed out MBBS:

I am pursuing PG after MBBS. I follow your posts regularly. I have a question: Does the passion we have to actually become doctors and serve society and those who need us actually fade away? Many of my friends tell me that there’s nothing like passion, only money matters after a while, and I should choose a degree which ensures good income. If so, sir, then the corporate culture must be right… the more you earn the better.. Then I would be happy to not pursue the PG and start clinic in villages and be happy with it.. Sorry for the long question but I feel I could get an answer.

Dear nextgen doc:
This answer is going to hurt many within and outside the profession. It will also expect your mature interpretation of what is being said. I beg forgiveness of those who find this unpleasant. In the first part I will mention some established facts, in the second I will offer my suggestion to the ever intelligent younger generation, which is always known to fight and improve upon the situation.

Facts as of now:

1. There is a huge difference in talking “Ideal and Good and Moral and Ethical” and actually doing it, and unfortunately we are in a society which blinds itself to this difference. Our society likes people who confidently talk about good and moral, while it harshly punishes / destroys those who try to unveil truth or hypocrisy. This is why the concept of “service to the society” is to be carefully interpreted.

2. By saying “ I want to do social service and help the poorest of the poor patients”, we also accept and sanction that this class will always be present in the society. It is a class created by the failures of society and government, not the doctors. If this class was not there (as in if the rural healthcare policies were worked upon and implemented without only the doctors being held responsible for them.. doctors don’t create patients or poverty), most Indian population would see dramatic evolution of better healthcare in India.

3. I do not see many passionate doctors now. Most who started out with the golden dream of living a respected, settled life and social gratitude for serving humanity are frustrated coping up with their rents, children’s school fees, mid-size car loans, restrictions and new rules by governments that leave the rich and powerful doctors and corporates out but shred the careers and lives of individual / small / middleclass medical practitioners.

4. The society or the government does not care if a doctor who has served it dies of poverty/ sickness / accident / occupational risk etc. There is no example of a good doctor’s family having been helped by society after his / her death. There is no insurance / protection / retirement benefit in return of medical social service of a doctor.

5. If it was only a question of serving and earning respect, let me tell you that patients make their own selfish choices always, and there is nothing wrong in that. But they will seldom stand by you in case of any mistake / problem you face, beyond curiosity and sympathy. On top of this, you are at the wish and whim of different laws, rules, regulations etc made by those who neither studied medicine nor practiced it especially in villages (from IAS to clerical class). They can call/ humiliate / dictate/ transfer / ask for bribe / disrespect/ ask personal favours / and still treat you like servant irrespective of whether you have done Nobel-prize-worthy social service.

6. A culture of choosing high-earning postgraduate seats has been encouraged in India, a nation of perpetually poor / low income intellectuals, who often have to avail of loans for education, and grow up with the natural desire of living a good, respectable and comfortable life, like everyone else. Government, Parents, teachers, senior doctors, etc., everyone has silently witnessed this process over years. However, we also have a highly pseudomoral society which expects service and honesty at the cost of a doctor’s life, without providing for his/ her needs according to his / her socio-intellectual standing, hardwork and skill. So whatever your education be in medical field, if you follow all laws and criteria of patient satisfaction, the equation is pretty screwed up: that you cannot see more than 20 patients in a day, you cannot refuse a nonpaying patient, you cannot advertise as an individual and so have no way to compete with hospitals who can advertise as they wish, the ethics and morals that individuals must follow do not apply to hospitals. There are umpteen impractical restrictions by governments, medical councils, even upon the most critical surgeries / procedures. This all restricts the income way too much, thus encouraging malpractice. Lower income PG seats are the last choice, and the PGs which have procedues / surgeries have become a choice because of multimodal incomes in these. Naturally, medical care is becoming more invasive. Also the pseudoawareness of the educated about medical procedures makes things worse as they think that the “best” must also come cheapest.

7. Very few of our earlier generation doctors feel responsible in any way for not having fought the evolution of medical profession to the state it is in today.. Success is measured by many a desperate doctors as medallions from the government, money and big hospital buildings, social and media image of a “Godman or Messiah” etc.. they have the money (how? Does not matter), they have the fame (for being present longest in the field… from a time there was no competition or even rules), so they go on advising moral and ethical floral bouquets to the younger generation docs publicly, but aimed at pleasing the media and the low intellect masses that highly depend upon the media to form their opinion. I would like to know how many “Rich and Famous” doctors from earlier generations have helped younger generation needy doctors with money / scholarships for higher education. Most PG seats have been created to earn more by selling degrees.

May I suggest:

Never underestimate your passion. It is the most important thing in life to pursue. But first, know your correct passion/ calling without thinking of something to impress others: you should be able to live with it irrespective of what people say about it, and you should be able to accept perpetual failure for that one passion: then alone it qualifies as your true passion. Finances / fame and social acceptance are not the aims of any passion.

The decision to live a life of low income / poverty is not easy, and is to be made only with the consent of your dependents / family: they did not sacrifice their active life so you cannot take care of them in their needy times. Your duty to take good care of your parents / children cannot be neglected. You may choose to pursue your passion without compromising upon your responsibilities. You will have a husband or wife and kids to grow, and it will be great injustice to your kids if you don’t provide them with a good and healthy childhood and education. Which Indian village has this? Also, for a good married life, you need to spend time with your spouse, otherwise you are doing him / her injustice.So if you have to do social service, do not marry or have children.

If your passion is for medicine, do not combine it with social service. Take your degree, go for higher education or research (both of which are pathetically lagging atleast 15 years behind the developed world, and no one is ashamed of this) and make India proud by working in a developed country which does justice to your medical talent.

If your passion is to medically serve the Indian poor patients, do not expect any financial remuneration, recognition or respect. I will personally respect you as a form of God, like the thousands who are actually doing this right now, all over India, without any recognition. Some of these are in govt service, some small individual and some hospital practitioners. Few with good connections get prizes / medallions / recognitions etc, and most of them either at the fag end of career (not because of their work, but the years they spent), or if they are rich. But then be prepared like myself to have to apply for loans, beg financial favours from people who will advise you about career and take advantage of you every which way they can.

I had made a conscious choice to return to India after the highest education as a passion towards serving poorest of the poor, and I have been made to regret this choice by silent earlier generation doctors who didn’t care what happened to next generation (In fact, it is the senior generations in private practice who kill most of the active practice of their next generation by various tactics), an inert government which really does not care about public health or doctors in general, a corporate culture that works purely as a profit making business, impractical rules / regulations not contested by medical bodies, and a society which prefers not to look beyond immediate selfishness.

There is hope, I am optimistic still (that’s why I am still writing this, staying here). But we now need a medical revolution.

(C) Rajas Deshpande

PS
I absolutely do not mean any disrespect towards the senior generation, including my teachers, who made me what I am today. I only mean that most of those who were in a position and power to make changes, did not do so. I have seen closely the financial and social (sometimes legal) frustration of many teachers who had abilities, and skills of a world-class doctor, but had to live perpetually in a state of financial insecurities. In spite of this, they have always encouraged ethical and moral behavior from us students. I must mention at the same time that if I give an impractical advice, which will push my students into a life of desperation, frustration and dependence, I will feel guilty about it.

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